Provider Demographics
NPI:1255465696
Name:BLEUEZ, SAMUEL B (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:B
Last Name:BLEUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1267 HIGHWAY 54 W
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2114
Mailing Address - Country:US
Mailing Address - Phone:770-716-0051
Mailing Address - Fax:770-716-0087
Practice Address - Street 1:1267 HIGHWAY 54 W
Practice Address - Street 2:SUITE 2200
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2114
Practice Address - Country:US
Practice Address - Phone:770-716-0051
Practice Address - Fax:770-716-0087
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY239289207R00000X
GA060241207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA043447662HIMedicaid
GA202I063065Medicare PIN